Age-related differences in prehospital triage and critical interventions: A multicenter TraumaRegister DGU® analysis

Purpose Older trauma patients are known to be undertriaged in the prehospital setting. However, it remains unclear whether these disparities translate into differences in the delivery of critical prehospital interventions. This study aimed to evaluate age-related differences in prehospital triage, allocation, and treatment within a physician-staffed emergency medical service system. Methods A retrospective multicenter analysis of the TraumaRegister DGU® was conducted, including trauma patients aged ≥ 20 years between 2020 and 2023 with trauma team activation and subsequent intensive care unit admission. Patients were stratified into two age groups, 20–59 vs. ≥60 years, with additional subgroups up to 90–99 years. Prehospital interventions, transport modality, and trauma center allocation were analyzed. Furthermore, predefined high-risk scenarios (severe motor vehicle trauma, traumatic brain injury with GCS ≤ 8, and pneumothorax) were evaluated. Results A total of 67,069 patients were included, with comparable injury severity across age groups (mean ISS 20.2). Older patients were less frequently transported by air and less often allocated to supra-regional trauma centers. While overall intervention rates were similar, differences emerged in high-risk scenarios. Older patients received endotracheal intubation and tranexamic acid less frequently despite comparable injury severity. Prehospital chest tube placement rates were low and similar across age groups. Conclusion Age-related differences in prehospital triage and allocation are associated with selective differences in treatment, particularly in high-risk situations. These findings suggest that prehospital care in older trauma patients is individualized rather than uniformly reduced, but highlight the need to refine triage algorithms and guideline implementation in an aging trauma population.